〔Abstract〕 Objective To explore the clinical value of carotid ultrasonography combined with active electrocardiography (AECG) in the diagnosis and evaluation of elderly patients with coronary heart disease (CHD). Methods A total of 167 elderly patients with suspected CHD who were admitted to the First Affiliated Hospital of Hunan College of Traditional Chinese Medicine from March 2018 to March 2020 were selected for carotid ultrasound and AECG examination. Coronary angiography (CAG) was regarded as the "gold standard". The sensitivity, specificity, accuracy, positive and negative predictive values, and carotid intima - media thickness (IMT) were analyzed. Results The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of carotid artery ultrasonography were 90.81%, 62.31%, 79.4%, 77.39% and 82.69% respectively. The sensitivity, specificity and accuracy of AECG were 77.55 %, 65.22 %, 72.45 %, 76.00 % and 67.16 % respectively. The specificity and positive predictive value of CAROTID ultrasonography combined with AECG in diagnosing CHD were higher than those of carotid ultrasonography combined with AECG alone (P < 0.05). The higher the number of coronary artery lesions, the higher the IMT value of carotid ultrasonography. Conclusions Both carotid ultrasound and AECG have good sensitivity in the diagnosis of elderly PATIENTS with CHD, but their specificity is low. The combination of the two can significantly improve the specificity and positive predictive value, providing a new idea for non-invasive screening of elderly patients with CHD.